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Long-term Renal Preservation and Complication Profile With Ileal Ureter Creation.

Authors :
Soyster ME
Burns RT
Slaven JE
Zappia JL
Arnold PJ
Roth JD
Bihrle R
Francesca Monn M
Mellon MJ
Source :
Urology [Urology] 2024 Jun; Vol. 188, pp. 138-143. Date of Electronic Publication: 2024 Apr 22.
Publication Year :
2024

Abstract

Objective: To examine long-term ileal ureter replacement results at over 32 years at our institution. Long segment or proximal ureteral strictures pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, Boari flap, buccal ureteroplasty, and autotransplantation are common reconstructive techniques. We show that ileal ureter remains a lasting option.<br />Methods: We performed a retrospective review of patients undergoing open ileal ureter creation from 1989-2021. Patient demographics, operative history, and complications were examined. All patients were followed for changes in renal function. Demographic data were analyzed and Cox proportional hazard models were performed.<br />Results: One hundred and fifty-eight patients were identified with median follow-up time of 40 months. Eighty-one percent had a unilateral ileal ureter creation. Fifty percent were female, median age was 53.3. Twenty-seven percent of patients had radiation-induced strictures. Preoperatively, 56.3% of patients were chronic kidney disease stage 1-2 and 43.7% were stage 3-5. Post-operatively, 54% were stage 1-2 and 46% were stage 3-5. Cox proportional hazard models demonstrated no significant correlation between worsening renal function and stricture cause, bilateral repair, complications, or sex (biologically male or female). Seventy-seven percent had no 30-day complications. Clavien complications included grade 1 (18), grade 2 (4), grade 3 (9), and grade 4 (5). Long-term complications included worsening renal function (3%), incisional hernia (8.2%), and small bowel obstruction (6.9%). Five (3.1%) patients ultimately required dialysis and 5 (3.1%) patients developed metabolic acidosis.<br />Conclusion: Ileal ureteral reconstruction is often a last resort for patients with complex ureteral injuries. Clinicians can be reassured by our long-term data that ileal ureteral creation is a safe treatment with good preservation of renal function and low risk of hemodialysis and metabolic acidosis.<br />Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1527-9995
Volume :
188
Database :
MEDLINE
Journal :
Urology
Publication Type :
Academic Journal
Accession number :
38657870
Full Text :
https://doi.org/10.1016/j.urology.2024.04.025